Dupuytrens Contracture
What is Dupuytren’s Contracture?
The hand is an incredibly intricate and coordinated part of the body, and there are many moving parts which glide over, around and through each other, and are separated by very specialised tissue layers called tissue planes that do not stick together and coordinate the beautiful movements of the various component parts of the hand – bone, ligaments, tendons, nerves and arteries.
Dupuytren’s disease is a malfunction of these tissue planes in the hand.
The disease often starts as a lump of what feels like scar tissue in the hand or fingers, and then progresses to form thick bands or chords that stretch from the palm into the fingers, and which when developed pull the fingers into a characteristically curled position, and ultimately render the finger(s) useless unless the disease is removed.
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About the Procedure
Dupuytren’s contracture is always a complex hand surgery when it is performed, and should never be undertaken lightly. Some forms of the contracture may look easy to treat, but the anatomical changes which the process precipitates can never be accurately predicted, and as such the hand surgeon must approach this condition with wisdom and caution at all times.
In addition, complications from surgery such as nerve damage and regional pain syndrome, are material risks, and so it is vital to weigh up the expected benefits of surgery with the potential risks and complications. Having said that, well performed hand surgery can “give people their hand back” and as such is extremely gratifying.
The surgery is extensive, and involves microsurgical dissection of the nerves and arteries in the fingers and hand, and resection of the disease process which infiltrates all the layers of the hand. Not surprisingly, after such extensive dissection, recovery from the operation is long and requires the involvement of a highly trained team of hand therapists, who are able to rehabilitate the tissue planes and guide the surgical scar development in such a way as to allow maximum return of function after surgery.
Dupuytren's Contracture Causes
The exact cause of Dupuytrens contracture is unknown, and many people talk about “Viking Disease” because of the genetic links of this disease process to people with Scandanavian heritage; An extraordinary number of elderly men (and women) in the UK and northern Europe are effected by this condition. Having said that, the whole area of gene expression is a very complex and poorly understood field and the medical community is currently advancing its collective knowledge of this at unprecedented rates.
Other associations with the disease are often contested, particularly in relation to work factors and the relationship between Dupuytrens contracture and occupations involving manual labour, vibrating tools and cold environments. While some studies back up these associations, others do not, and currently Work Cover is fairly harsh in its exclusions of these cases from compensation.
Our Expertise
Mr Crock has over 30 years of experience in treating this disease, and has made it one of his special interests. Whilst he practices a wide range of surgeries known to be associated with plastic surgery, his fascination with the intricate structure of the human body is what makes the palmar fasciectomy and its subsequent reconstruction with flaps and grafts, such a key part of his practice and expertise.
Mr Crock was involved in the development of the drug “Xiaflex” used to treat Dupuytren’s contracture non surgically with minimally invasive techniques. He was a chief investigator for phase 2 and 3 trials in Australia, and the drug was release circa 2016, but was withdrawn around 2021 because the drug was not funded by medicare and as such became very expensive for patients. In addition, the disease would recur after treatment in a significant percentage of patients.
Hand surgery for the treatment of Dupuytren’s contracture can be discussed at the Knox Plastic Surgery clinic on request.